Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study
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Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success.
Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events.
In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed.
ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.
KeywordsEndoscopic sleeve gastroplasty Weight loss Obesity Endoscopic bariatric therapy Endoscopic suturing
argon plasma coagulation
endoscopic bariatric therapy
endoscopic sleeve gastroplasty
excess weight loss
obesity-related chronic disease/condition
total body weight loss
AS and VK had the concept of the work. AS, VK, and ZS completed data analysis and interpretation. All the authors had equal contributions in data collection, drafting the article, and critical revision of the article. All authors approved the final version of the article for publication.
Compliance with Ethical Standards
Conflicts of Interest
AS, EW, and VK are consultants with Apollo Endosurgery. AS and GM are consultants for BAROnova. VK is also a consultant for Boston Scientific, Reshape Medical, and Medtronic. MAK is a consultant for Boston Scientific and Olympus America. ANK is a founding member, equity holder, and consultant for Apollo Endosurgery. EW is a consultant for Gore, Intuitive, Ethicon, Olympus, and EndoGastric Solutions. The remaining authors disclose no conflict of interest.
All procedures performed in the study were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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